Q fever in Plymouth, 1972–88: A review with particular reference to neurological manifestations

Abstract

SUMMARYBetween 1972 and 1988 we have serologically confirmed 103 Coxiella burnetii infections: 46 were acute, 5 were chronic, 52 represented past infections. Details of 61 cases are presented.Of acute cases 80 % had respiratory involvement; at least 63 % had pneumonias. The incidence (22 %) of neurological complications was of particular interest; 40% of these patients had prolonged sequelae. One acutely ill patient died of fulminating hepatitis. Patients with pre-existing pathology or immunosuppression were especially susceptible to C. burnetii.In the absence of acute sera, the complement fixation test alone provided inadequate differentiation between recent and past Q fever: phase II titres persisted at 3 80 for more than 1 year after the acute infection in 15 cases; maximum duration of persistence was 14 years. Three patients acquired high phase I titres.Only 5% of cases had chronic Q fever, but in view of the diverse sequelae observed in this series, we suggest that long-term serological and clinical followup of all cases of Q fever is fully justified.

Invasion of the Central Nervous System by Intracellular Bacteria

“…After exclusion of patients with a normal CSF examination, the authors concluded that the prevalence of serious neurological symptoms was 2.2% (38). By comparison, a different series reported an incidence of neurological symptoms of 22% (314). A variety of manifestations of CNS disease in Q fever have been reported, including meningitis and meningoencephalitis in 0.5 and 1% of patients, respectively (311), neck stiffness in 5%, and confusion and apathy in 7% (64).…”

Newer Macrolides as Empiric Treatment for Acute Q Fever Infection

“…The treatment of choice for acute Q fever is considered doxycycline (8,15), but the diagnosis often is missed, and macrolides and other antibiotics considered ineffective in vitro are usually used. (17) Respiratory involvement with an atypical pneumonia syndrome is the predominant clinical presentation of Q fever in most published studies (3,10,14,16).…”

Aseptic Meningitis Caused by Coxiella Burnetii

“…In our case, pleocytosis was mainly because of polymorphonuclear cells, but this is a well-known phenomenon in the initial stages of several lymphocytic meningitis, such as viral, spirochetal, mycobacterial or fungal meningitis. In contrast to Bernit et al's 2 study, Reilly et al 6 reported a rate of 22% regarding neurologic complications in acute Q fever, which suggests that it may not be so rare.…”